Prevention of Hepatitis in risk groups and hepatitis and HIV in Albania
Ass.Prof. Najada COMO
Infectious Diseases Clinic UHC “Mother Theresa” Tirane
VHPB Meeting
Rogner,Tirane,Albania,27‐28October2016
t National Center of upbringing,the Child Development and Rehabilitation
The National Center for
Blood Transfusion
University Dental CliniC
Organization of the Epidemiological Health System In Albania
Ministry OF Health
IPH
Third Diagnostic and curative health service UHC “Mother Theresa”
Second Diagnostic and curative health service
Primary Diagnostic and curative health service
Referral of HIV /HBV /HCV Patients to Infectious Diseases Service UHC
Direct
2nd
Regional hosp
IPH
Blood bankPrisons
Oncology,Hematology, Nefrology ,Toxicology,Hemodialysis UnitsUHC “Mother Theresa”
GP
Infectious Diseases Service
UHC MotherTheresa
Modes of transmission
Contact with infectious blood, semen and other bodily fluids, primarily through:
‐ Sexual contact with a hepatitis B‐infected person; ‐ Birth from a hepatitis B‐infected mother at the time of birth or from family member to infant in early childhood;‐ Sharing needles, syringes or drug paraphernalia (works);‐ Transfusions of HBV‐contaminated blood and blood products; ‐ Needle sticks or sharp instrument injuries;‐ Contaminated injections during medical procedures‐Tattooing/body piercing
Risk groups
1.Newborns 2.Multiple transfusion and dialysispatients, patients admitted in hospitals3.Health care workers and Medical university students4.Injection drug users 5.Roma communities 6.MSM 7.Prisons 8.Traficed people
Prevalence of possitivity of HbsAg and HCV in Albania
Geographicaly distribution in total HBV and HCV
Seroprevalence studies undertaken over the years by IPH in our country is estimated that about 200,000 individuals are infected with HBV , with a prevalence that ranges from 7- 9%, and about 30,000 people with HCV , with a prevalence ranging from 0.5 to 1.5%.
Hepatitis C prevalence is much higher in some population groups, such as MSM , or IDU
Ref:IIPH Hepatitis draft
Profilaxia Hepatitis B in the Risk Groups In 1994 it started to neonatal vaccination and then it became part
of the national vaccination schedule for children during the first year of life. From this time and onwards are vaccinated over 1 million people against HBV
In recent years they have been carried out vaccinations in selected groups1. 2001‐2002 in the UHC employees and medical students2. 2012 revaccination to UHC staff and nursing students, medicine and dentistry3. Patients of dialysis4. Travelers in countries with high risk5. MSM6. In HIV infected people and them with Co infection HIV/ HCV
Situation of HIV/HBV and HIV/HCV in ID CLINIC UHC ”Mother Theresa“
Situation of HIV/AIDS in Albania 1993 ‐ 2016
Co infectious HIV/Hepatitis follows the same growthcurve, especially recent years
The incidence of HIV in our country is 0,03% and the prevalence 0.003%, untill November 2014 .
Although the prevalence of HIV infection is low, there has been an increasing trend in the number of new cases in recent years
29 12 7 3 5 4 10
20 26 2129 31 32
44 4961
48
72
90
124
84 87
64
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Nr.R
aste
- HIV - AIDS
Distribution of HIV/HBV/HCV based on Agegroup
The highest number belongs to age groups 20‐40 years old
Distribution of our HIV / HBV and HIV / HCV cases at the time of registration in the outpatient clinic,
according to the CDC clinical classification
A1 1 case
A2 5
A3 6
B1 8
B2 9
B3 13
C1 11
C2 8
C3 23
CDC clinical stage HIV/AIDS HIV/HBV/HCV cases ( In Tot )
The highest number noted in stage C ( C1,C2,C3 )…they are presented in late stage of HIV
IN 2011 we swichted some of them in TDF/TC + EFV‐ Cases failed‐ Those with side effects from ZDV
‐ New cases with coinfeksion used it as the first line
Since 2013 we performed
• Fibroscan in 40 pts F0‐F1 4, F1 F2 = 25, F3 = 12
• HBV DNA > 2 000 Ui/ml 32 cases
•The other cases are filled with serological and virological HBV tests
ART schemes used in HIV ‐ HBV cases
Antiviral used for HCV
‐In Tot 15 cases HIV‐HCV
In 9 of them we performed ‐Fibroscan‐Genotype ‐HCV RNA / HIV RNA in base line and after therapy‐We used PEG INF + RIB based on criteria of HIV/HCV treatment‐ 6 of them has undetectable
HCV RNA‐ 3 cases have low level HCV RNA 2 cases dead (Late stage ofHIV) 4 are testing for HCV RNA / HIV
RNA level, genotype, Fibroscanand CD4 cell/count
ARV combination on HIV – HCV cases
Conclusions • The rising trend of HIV has been associated with increased incidence of Co
‐ infections• It is a higher concentration in the big citys• Actualy in Albania we can diagnose, treat and follow up Not Even HIV but
and HIV co infectionsHIV / HBVHIV / HDV and HIV / HCV
• Exit the database of Co Infection HIV / Hepatitis where adults are different
in epidemiological Aspects
Problems • Difficulties on aderence of pacients with therapy
• Difficulties laboratory, farmacology and optimal collaboration beetwen differents units who take with these problems
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